Plays of the Week – 12/18/08
December 18, 2008 
8 Comments
Welcome to another edition of Plays of the Week.
Links of the Week
- I have a whole new section at the very bottom of my website designed to allow more interaction. One of the things that I hate most about blogs is that they are very one-dimensional, with one writer and many readers. That is why I really appreciate all the comments after each post, creates such a good discussion, such as the one we had this week on assessing and treating dysfunction of the gluteus medius and last week on my top 5 least favorite rehabilitation exercises. That last post had 21 comments, which is awesome! That is one of the reasons why I do not create a new post each day. I want to spend a few days discussing and reading reactions to each post so that we all get more out of the experience. Scroll to the bottom of this page (or visit the website if reading this in your email or RSS reader) to see the new interaction section. You can read/post comments to my posts, vote on future posts you want to see here, follow me on twitter, and start your own discussion by asking a question to the group. Join the community and interact!
- Jason Harris has a nice overview on his blog of the newly outlined Guidelines for the Treatment of Osteoarthritis of the Knee by American Academy of Orthopedic Surgeons. Jason highlights a few items included in the 265 page document. Apparently the AAOS decided to recommend many treatments that are commonly performed but avoid recommending “physical therapy” itself. Interesting information Jason.
- Mark Scwhall blogged about the up-and-coming new wikipedia-style website for physical therapy, Physiopedia. I love the idea and commend Eric Robertson and Rachael Lowe for beginning this project. They are actively seeking people to join in on the project and contribute.
- Strength and conditioning guru Vern Gambetta had a nice little rant about rotational exercises not be harmful. I agree with Vern, rotational exercises are needed but must be done correctly to not be too stressful.
- Eric Robertson has an interview with John Childs on his blog regarding spinal manipulative therapy.
- Rod Henderson was on fire the last two weeks, blasting out blog post reviews of journal articles on the posterior capsule of the shoulder, conservative management of rotator cuff tears, peripheral nerve function during shoulder arthroplasty, and a review of topics he recently learned on neuroscience. Rod stepped it up these last couple of weeks with several quality posts for us to read.
- I don’t want to take any of the credit, but I think I may have spurred Rod’s research and post on the posterior capsule. We had a very long and informative discussion on the forums on www.rehabedge.com. Check out our discussion over the last couple of weeks. I apologize in advance but discussing the “theory” of posterior capsule tightness often times gets me worked up!
- Leon Chaitow has a new blog post on biomechanics, malalignment, and adaptation. Always good to here what is new from Leon. Looking forward to the new book that he mentions in this post as well.
- Stay tuned for a guest post by Christie Downing next week on the role of predicting negative outcomes and chronic disability. If you have a topic you would like to guest post on, please contact me!
Book of the Week 
This week’s Book of the Week is Rapidly Reversible Low Back Pain by Dr. Ronald Donelson. This book came recommended to me by many colleagues. I was a little skeptical at first as the book sort of has a gimmicky title, but it is a pleasant surprise. I choose this for the book of the week because it is of topic in Christie Downing’s guest post. The book overviews a bit of the McKenzie theory behind low back pain treatment with surprising accuracy and simplicity. It is better that 95% of “textbooks” that are supposed to teach you how to treat low back pain. What I liked best about the book was the immediate ability to take information and apply it to next low back pain patients the next day.
The book received 5 out of 5 stars from all reviewers and is under $20 on Amazon! Click here for more information or to purchase from Amazon. From the editorial review of the book:
In this hard-to-put-down account, he accurately exposes flaws in the low back pain scientific process and then offers simple, logical remedies. His insightful review of this valuable, yet ironically overlooked, clinical research reveals both clinical and economic solutions from implementing patient-specific treatments, rather than the "one-size-fits-all" guideline recommendations. This refreshing approach offers clinicians clinical methods to objectively determine non-pharmacologic ways for patients to gain control of their own low back pain and to recover more quickly and simply.
Rehab Product of the Week
This week’s Rehab Product of the Week is the Massage Stick. These little guys are excellent devices to perform deep manual massage techniques as a clinician as well as self-massage at home for the patient. One of those products that you will use on
your patients and they will ask where they can buy one for home. They are really pretty addicting because they REALLY work well. They save you some energy with your hands when you need to perform deep tissue work to lengthen a muscle. Plus, at under $50 it is far cheaper than some other “techniques” that cost $1000’s to learn and you actually get to keep the massage tool if you don’t pay the yearly “certification fee” to rent the tools. Many of you probably know what I am referring to. Spend the $50 and keep the $1950 for something more important, like a mortgage payment. Check them out at Perform Better. ONE NOTE THOUGH – I don’t recommend getting the small one or the stiff one, the concept is good and I bought those too, but they just aren’t as good. They are not as flexible so don’t wrap around a muscle as well. Stick to the original. Here is a video of it in action:
I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
Deborah
Term Life Insurance
Interesting blog, would love to visit and read more stuffs related to back pain. While looking for information on back pain and spinal decompression, I came across your blog. I would suggest people with back pain to refer to this as well
http://www.spinaldiscdecompression.com/
Keira… not sure that you’re going to find a lot of support for spinal decompression here(a.k.a. traction). We have a chiro in town that “informs” his patients of 98% success rate with this treatment regardless of how bad their back pain and radicular symptoms are. Best thing for the chiro is that he gets $100 cash per visit for 36 visits while a “tech” oversees the treatment. Those folks love it when I see them after the “decompression” was not successful and I tell them their insurance pays us around $15 per visit for comparable treatment (traction). In my opinion it is a HUGE scam (i.e., “NASA technology”), but maybe others on here disagree???
Traction and low back pain— not a whole lot out there to support its use. But, Fritz does have a nice article to suggest some utility in the presence of leg symptoms that either peripheralize with extension or the crossed SLR.
Spine Vol 32 No 26 pp E793-jE800.
P.S. Love to see a post on post capsule tightness with a discussion on its “presence”.
Amy, I can assure you that the spinal decompression folks (such as the rep that’s trying to hijack Mike’s blog) are not using the inclusion criteria of Fritz, Cleland, and Childs. The inclusion for spinal decompression is typically anyone with back and/or LE Sxs, which just about everyone that reads this bolg knows is far from EBM.
The widely touted “success” rate of 86% of spinal decompression is easy to get when the vast majority of your patients are people with single level herniations without degeneration, no control group is employed, baseline characteriestics such as duration of symptoms amongst groups are not described, nor is length of time of outcomes described.
The highly quoted Goines study that appluads the effects of DRX 9000 does not include control groups, has a significant portion of their population with single level protrustions and does not describe at what point in time recovery occurred. Once one starts examining those with more significant MRI findings, the results quickly drop as low at 68%. Again, long term outcomes were not reported. To me, this is no more impressive than “standard physical therapy” (whatever that may be). …and for about $17,000 less no doubt.
Seriously, let’s forget the fact that MRI findings may be irrelevant, but let’s say they are…how many people do you see who have single level lesions without degeneration?
Heck, Long’s study “Does it matter which exercise” found that 90% of patients with a directional preference were pain free or significantly better in two weeks with direction specific exercises. Does that mean the McKenzie world is touting a 90% success rate? No, because we know long term studies need to be considered. (however, I would argue that the nature of rapid reduction of symptoms with primarily self directed treatment is a win-win when compared with spinal decompression).
No other large study has been able to replicate the study done by Goines.
Keria, I highly recommend you review the literature on spinal decompression more carefully.
Sorry for the tough crowd Keria, but I think the skepticism to you post is valid considering your “advertisement” for your web site!
Love all the evidence guys, you know what comes to my mind first? If these patients received treatments for 2-4 weeks would they have gotten better anyway? Where they doing nothing all day except traction? Just like anything else, it is a tool, though a very small tool, in our chest for a very specific patient.
Amy – good idea for a post topic, something I will hit after the holidays. Thanks for the input!